Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

INTRA-ABD OMENTAL FLAP

Facility

$1,439.84

Service Code	HCPCS 49905
Hospital Charge Code	1600000436
Hospital Revenue Code	360
Min. Negotiated Rate	$215.98
Max. Negotiated Rate	$215.98
Rate for Payer: Qualcare PPO/HMO/WC	$215.98

INTRA-ABD OMENTAL FLAP

Facility

$1,439.84

Service Code	HCPCS 49905
Hospital Charge Code	1600000436
Hospital Revenue Code	360
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$547.14
Rate for Payer: Aetna Medicare Advantage	$431.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$367.16
Rate for Payer: Cigna Commercial	$719.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$431.95
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$215.98
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$34.70
Rate for Payer: Wellpoint Medicaid Managed Care	$38.16

INTRA-ABD OMENTAL FLAP

Facility

$1,439.84

Service Code	HCPCS 49905
Hospital Charge Code	1600000499
Hospital Revenue Code	360
Min. Negotiated Rate	$34.70
Max. Negotiated Rate	$10,232.00
Rate for Payer: Aetna Commercial	$547.14
Rate for Payer: Aetna Medicare Advantage	$431.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$367.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$367.16
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$367.16
Rate for Payer: Cigna Commercial	$719.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$431.95
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$215.98
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$34.70
Rate for Payer: Wellpoint Medicaid Managed Care	$38.16

INTRACARDIAC ECG

Facility

$750.00

Service Code	HCPCS 93662
Hospital Charge Code	7411251
Hospital Revenue Code	480
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$112.50
Rate for Payer: Qualcare PPO/HMO/WC	$112.50

INTRACARDIAC ECG

Facility

$750.00

Service Code	HCPCS 93662
Hospital Charge Code	7411251
Hospital Revenue Code	480
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$2,770.00
Rate for Payer: Aetna Commercial	$285.00
Rate for Payer: Aetna Medicare Advantage	$225.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$340.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.25
Rate for Payer: Cigna Commercial	$375.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$225.00
Rate for Payer: Oxford Commercial	$1,580.00
Rate for Payer: Qualcare PPO/HMO/WC	$112.50
Rate for Payer: UnitedHealthcare Commercial	$2,770.00
Rate for Payer: UnitedHealthcare Community & State	$18.07
Rate for Payer: Wellpoint Medicaid Managed Care	$19.88

INTRACATH 16GX8 YELLOW

Facility

$38.00

Hospital Charge Code	270331478
Hospital Revenue Code	272
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$19.00
Rate for Payer: Aetna Commercial	$14.44
Rate for Payer: Aetna Medicare Advantage	$11.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.69
Rate for Payer: Cigna Commercial	$19.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$11.40
Rate for Payer: Oxford Commercial	$7.60
Rate for Payer: Qualcare PPO/HMO/WC	$5.70
Rate for Payer: UnitedHealthcare Commercial	$7.60
Rate for Payer: UnitedHealthcare Community & State	$0.92
Rate for Payer: Wellpoint Medicaid Managed Care	$1.01

INTRACATH 16GX8 YELLOW

Facility

$38.00

Hospital Charge Code	270331478
Hospital Revenue Code	272
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$5.70
Rate for Payer: Qualcare PPO/HMO/WC	$5.70

INTRACRAN ANGIOPLASTY W STENT

Facility

$58,920.00

Service Code	HCPCS 61635
Hospital Charge Code	411061635
Hospital Revenue Code	360
Min. Negotiated Rate	$1,419.97
Max. Negotiated Rate	$29,460.00
Rate for Payer: Aetna Commercial	$22,389.60
Rate for Payer: Aetna Medicare Advantage	$17,676.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,024.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,024.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,024.60
Rate for Payer: Cigna Commercial	$29,460.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17,676.00
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,838.00
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,419.97
Rate for Payer: Wellpoint Medicaid Managed Care	$1,561.38

INTRACRAN ANGIOPLASTY W STENT

Facility

$58,920.00

Service Code	HCPCS 61635
Hospital Charge Code	411061635
Hospital Revenue Code	360
Min. Negotiated Rate	$8,838.00
Max. Negotiated Rate	$8,838.00
Rate for Payer: Qualcare PPO/HMO/WC	$8,838.00

INTRACRANIAL ANGIOPLASTY

Facility

$61,616.39

Service Code	HCPCS 61630
Hospital Charge Code	411061630
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

INTRACRANIAL ANGIOPLASTY

Facility

$61,616.39

Service Code	HCPCS 61630
Hospital Charge Code	411061630
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

INTRACRANIAL ANGIOPLASTY

Facility

$61,616.39

Service Code	HCPCS 61630
Hospital Charge Code	366861630
Hospital Revenue Code	361
Min. Negotiated Rate	$1,484.95
Max. Negotiated Rate	$30,808.19
Rate for Payer: Aetna Commercial	$23,414.23
Rate for Payer: Aetna Medicare Advantage	$18,484.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$15,712.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$1,626.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$15,712.18
Rate for Payer: Cigna Commercial	$30,808.19
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18,484.92
Rate for Payer: Oxford Commercial	$6,055.00
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46
Rate for Payer: UnitedHealthcare Commercial	$10,232.00
Rate for Payer: UnitedHealthcare Community & State	$1,484.95
Rate for Payer: Wellpoint Medicaid Managed Care	$1,632.83

INTRACRANIAL ANGIOPLASTY

Facility

$61,616.39

Service Code	HCPCS 61630
Hospital Charge Code	366861630
Hospital Revenue Code	361
Min. Negotiated Rate	$9,242.46
Max. Negotiated Rate	$9,242.46
Rate for Payer: Qualcare PPO/HMO/WC	$9,242.46

INTRACRANIAL HEMORRHAGE

Facility

$9,213.99

Service Code	APR-DRG 0441
Min. Negotiated Rate	$9,033.32
Max. Negotiated Rate	$9,213.99
Rate for Payer: UnitedHealthcare Community & State	$9,033.32
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$9,213.99
Rate for Payer: Wellpoint Medicaid Managed Care	$9,033.32

INTRACRANIAL HEMORRHAGE

Facility

$16,723.62

Service Code	APR-DRG 0443
Min. Negotiated Rate	$16,395.71
Max. Negotiated Rate	$16,723.62
Rate for Payer: UnitedHealthcare Community & State	$16,395.71
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$16,723.62
Rate for Payer: Wellpoint Medicaid Managed Care	$16,395.71

INTRACRANIAL HEMORRHAGE

Facility

$19,173.60

Service Code	APR-DRG 0444
Min. Negotiated Rate	$18,797.65
Max. Negotiated Rate	$19,173.60
Rate for Payer: UnitedHealthcare Community & State	$18,797.65
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$19,173.60
Rate for Payer: Wellpoint Medicaid Managed Care	$18,797.65

INTRACRANIAL HEMORRHAGE

Facility

$12,818.19

Service Code	APR-DRG 0442
Min. Negotiated Rate	$12,566.85
Max. Negotiated Rate	$12,818.19
Rate for Payer: UnitedHealthcare Community & State	$12,566.85
Rate for Payer: Wellcare New Jersey Medicaid/Family Care	$12,818.19
Rate for Payer: Wellpoint Medicaid Managed Care	$12,566.85

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS

Facility

$34,788.62

Service Code	MSDRG 065
Min. Negotiated Rate	$10,592.69
Max. Negotiated Rate	$34,788.62
Rate for Payer: Aetna Medicare Advantage	$34,788.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$23,726.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$23,726.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$11,150.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$23,726.22
Rate for Payer: Cigna Commercial	$18,906.75
Rate for Payer: Cigna Medicare Advantage	$11,150.20
Rate for Payer: Clover Medicare Advantage	$10,592.69
Rate for Payer: EmblemHealth Commercial	$33,450.60
Rate for Payer: Humana Medicare Advantage	$11,484.71
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$11,150.20
Rate for Payer: Oxford Commercial	$13,588.53
Rate for Payer: UnitedHealthcare Commercial	$23,827.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$11,150.20
Rate for Payer: Wellcare Medicare Advantage	$11,150.20

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC

Facility

$67,132.88

Service Code	MSDRG 064
Min. Negotiated Rate	$20,441.10
Max. Negotiated Rate	$67,132.88
Rate for Payer: Aetna Medicare Advantage	$67,132.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46,522.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46,522.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$21,516.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46,522.00
Rate for Payer: Cigna Commercial	$37,633.85
Rate for Payer: Cigna Medicare Advantage	$21,516.95
Rate for Payer: Clover Medicare Advantage	$20,441.10
Rate for Payer: EmblemHealth Commercial	$64,550.85
Rate for Payer: Humana Medicare Advantage	$22,162.46
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$21,516.95
Rate for Payer: Oxford Commercial	$27,047.95
Rate for Payer: UnitedHealthcare Commercial	$47,429.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$21,516.95
Rate for Payer: Wellcare Medicare Advantage	$21,516.95

INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC

Facility

$24,255.04

Service Code	MSDRG 066
Min. Negotiated Rate	$7,385.35
Max. Negotiated Rate	$24,255.04
Rate for Payer: Aetna Medicare Advantage	$24,255.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16,050.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16,050.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$7,774.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16,050.09
Rate for Payer: Cigna Commercial	$12,807.86
Rate for Payer: Cigna Medicare Advantage	$7,774.05
Rate for Payer: Clover Medicare Advantage	$7,385.35
Rate for Payer: EmblemHealth Commercial	$23,322.15
Rate for Payer: Humana Medicare Advantage	$8,007.27
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$7,774.05
Rate for Payer: Oxford Commercial	$9,205.18
Rate for Payer: UnitedHealthcare Commercial	$16,141.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$7,774.05
Rate for Payer: Wellcare Medicare Advantage	$7,774.05

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC

Facility

$173,238.44

Service Code	MSDRG 021
Min. Negotiated Rate	$52,748.88
Max. Negotiated Rate	$173,238.44
Rate for Payer: Aetna Medicare Advantage	$173,238.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142,822.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142,822.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$55,525.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142,822.54
Rate for Payer: Cigna Commercial	$99,068.17
Rate for Payer: Cigna Medicare Advantage	$55,525.14
Rate for Payer: Clover Medicare Advantage	$52,748.88
Rate for Payer: EmblemHealth Commercial	$166,575.42
Rate for Payer: Humana Medicare Advantage	$57,190.89
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$55,525.14
Rate for Payer: Oxford Commercial	$71,201.61
Rate for Payer: UnitedHealthcare Commercial	$124,854.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$55,525.14
Rate for Payer: Wellcare Medicare Advantage	$55,525.14

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC

Facility

$256,466.65

Service Code	MSDRG 020
Min. Negotiated Rate	$78,090.81
Max. Negotiated Rate	$256,466.65
Rate for Payer: Aetna Medicare Advantage	$256,466.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$196,555.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$196,555.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$82,200.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$196,555.45
Rate for Payer: Cigna Commercial	$147,256.72
Rate for Payer: Cigna Medicare Advantage	$82,200.85
Rate for Payer: Clover Medicare Advantage	$78,090.81
Rate for Payer: EmblemHealth Commercial	$246,602.55
Rate for Payer: Humana Medicare Advantage	$84,666.88
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$82,200.85
Rate for Payer: Oxford Commercial	$105,835.36
Rate for Payer: UnitedHealthcare Commercial	$185,585.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$82,200.85
Rate for Payer: Wellcare Medicare Advantage	$82,200.85

INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC

Facility

$104,832.90

Service Code	MSDRG 022
Min. Negotiated Rate	$31,920.28
Max. Negotiated Rate	$104,832.90
Rate for Payer: Aetna Medicare Advantage	$104,832.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$91,183.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$91,183.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$33,600.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$91,183.12
Rate for Payer: Cigna Commercial	$57,547.42
Rate for Payer: Cigna Medicare Advantage	$33,600.29
Rate for Payer: Clover Medicare Advantage	$31,920.28
Rate for Payer: EmblemHealth Commercial	$100,800.87
Rate for Payer: Humana Medicare Advantage	$34,608.30
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$33,600.29
Rate for Payer: Oxford Commercial	$41,360.10
Rate for Payer: UnitedHealthcare Commercial	$72,526.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$33,600.29
Rate for Payer: Wellcare Medicare Advantage	$33,600.29

INTRAFIX PEEK TP SCR 8-10x30MM

Facility

$1,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270673367
Hospital Revenue Code	278
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$343.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$312.40
Rate for Payer: Qualcare PPO/HMO/WC	$213.00

INTRAFIX PEEK TP SCR 8-10x30MM

Facility

$1,420.00

Service Code	HCPCS C1713
Hospital Charge Code	270673367
Hospital Revenue Code	278
Min. Negotiated Rate	$34.22
Max. Negotiated Rate	$710.00
Rate for Payer: Aetna Commercial	$539.60
Rate for Payer: Aetna Medicare Advantage	$426.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$362.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$362.10
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$284.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$362.10
Rate for Payer: Cigna Commercial	$710.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$343.64
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$312.40
Rate for Payer: Qualcare PPO/HMO/WC	$213.00
Rate for Payer: UnitedHealthcare Community & State	$34.22
Rate for Payer: Wellpoint Medicaid Managed Care	$37.63

Know your out-of-pocket cost for care.

All Charges